{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:08:37Z","timestamp":1788304117019,"version":"build-2803163510"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T00:00:00Z","timestamp":1679616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>To ascertain the presence of Dry Eye Syndrome (DES) in patients being treated for glaucoma, using subjective and objective methods and to examine DES impact on their quality of life (QOL).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>A cross-sectional study was conducted by employing 156 glaucoma patients recruited from treatment centers in the Cape Coast Metropolis in Ghana. All the participants underwent dry eye examination and completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ), the Dry Eye-related Quality of Life Score (DEQS) and the Ocular Surface Disease Index (OSDI). Comparisons of the clinical tests, NEI VFQ-25 subscale item and composite scores and scores of DEQS and OSDI were made among subgroups divided according to the presence of dry eye symptoms or signs. Multivariate logistic regression analysis was performed to investigate the factors that influence DES related-QOL among the patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The study involved 156 subjects with a mean age of 47.88 \u00b1 16.0 years and made up of 81 (51.9%) females and 75 (48.1%) males. A One-Way ANOVA was conducted, and the F-statistic (F) indicated that there was a significant difference in the mean scores of the groups. There were significantly lower Tear break-up time (TBUT) values found in the group with definite dry compared with the group without DES and the group that was symptomatic with no signs DES in both eyes, [(F(3,151) = 13.703, p&lt;0.001 (RE): (F(3,152) = 18.992, p&lt;0.001 (LE)]. Similar results were found for Schirmer test (ST) [(F (3,151) = 28.895, p&lt;0.001 (RE): (F (3,152) = 17.410, p&lt;0.001 (LE)]. There was statistically significant difference in the mean composite score (64.93 \u00b1 20.27) for the NEI VFQ-25 and sub-scale score of ocular pain, which was significantly lower in the group with definite dry as compared to other sub-groups (F(3,152) = 4.559, p = 0.004). OSDI scores of the group with definite dry eye (47.69\u201319.17) and the group that was symptomatic but with no signs (38.90\u201322.44) were significantly higher than those without dry eye and those that were asymptomatic but had a sign (F(3,152) = 17.896, p&lt;0.001), with a similar trend occurring in the groups with relation to DEQS scores (F(3,152) = 8.775, p&lt;0.001). There was a strong correlation between the DEQS and the OSDI questionnaires, and a weak correlation between the DEQS and the NEI VFQ-25 questionnaire after adjusting for all other factors (all p &lt; 0.01).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The study established a high presence of DES and consequently low DES related-QOL in glaucoma patients. Dry eye questionnaires are able to discriminate those who have definite dry eye from the other groups, showing its appropriateness for clinical use in glaucoma patients. Ocular surface evaluation should be conducted among glaucoma patients on topical anti-glaucoma therapy to ensure the timely detection and treatment of signs and symptoms of DES and improvement of dry-eye related QOL.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0283597","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T17:29:36Z","timestamp":1679678976000},"page":"e0283597","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Dry eye symptom questionnaires show adequate measurement precision and psychometric validity for clinical assessment of vision-related quality of life in glaucoma patients"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3992-0969","authenticated-orcid":true,"given":"Stephen","family":"Ocansey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8841-8628","authenticated-orcid":true,"given":"Ebenezer Oduro","family":"Antiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1733-3509","authenticated-orcid":true,"given":"Carl Haladay","family":"Abraham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel Kwasi","family":"Abu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"issue":"1","key":"pone.0283597.ref001","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1001\/archopht.121.1.48","article-title":"Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma","volume":"12","author":"MC Leske","year":"2003","journal-title":"Arch Ophthalmol"},{"issue":"3","key":"pone.0283597.ref002","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1136\/bjo.2005.081224","article-title":"The number of people with glaucoma worldwide in 2010 and 2020","volume":"90","author":"HA Quigley","year":"2006","journal-title":"Br J Ophthalmol"},{"issue":"1","key":"pone.0283597.ref003","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4314\/njo.v14i1.11977","article-title":"Primary open-angle glaucoma in Sub-Saharan Africa","volume":"14","author":"JC Mwanza","year":"2006","journal-title":"Niger J Ophthalmol"},{"issue":"6","key":"pone.0283597.ref004","first-page":"373","article-title":"The current status of glaucoma and glaucoma care in sub-Saharan Africa","volume":"7","author":"F Kyari","year":"2018","journal-title":"Asia-Pacific J Ophthalmol"},{"issue":"7","key":"pone.0283597.ref005","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1136\/bjo.80.7.583","article-title":"To preserve or not to preserve, is that the question?","volume":"80","author":"LA Wilson","year":"1996","journal-title":"Br J Ophthalmol"},{"issue":"7","key":"pone.0283597.ref006","doi-asserted-by":"crossref","first-page":"2444","DOI":"10.1167\/iovs.04-1331","article-title":"In vitro study of inflammatory potential and toxicity profile of latanoprost, travoprost, and bimatoprost in conjunctiva-derived epithelial cells","volume":"46","author":"JM Guenoun","year":"2005","journal-title":"Investig Ophthalmol Vis Sci"},{"issue":"11","key":"pone.0283597.ref007","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1136\/bjophthalmol-2017-311544","article-title":"Preservatives in glaucoma medication","volume":"102","author":"DW Steven","year":"2018","journal-title":"Br J Ophthalmol"},{"issue":"4","key":"pone.0283597.ref008","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1136\/bjo.86.4.418","article-title":"Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication","volume":"86","author":"PJ Pisella","year":"2002","journal-title":"Br J Ophthalmol"},{"key":"pone.0283597.ref009","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jtos.2017.05.008","article-title":"TFOS DEWS II Definition and Classification Report","volume":"15","author":"JP Craig","year":"2017","journal-title":"Ocul Surf"},{"issue":"3","key":"pone.0283597.ref010","first-page":"642","article-title":"Quaternary ammoniums and other preservatives\u2019 contribution in oxidative stress and apoptosis on Chang conjunctival cells","volume":"42","author":"C Debbasch","year":"2001","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0283597.ref011","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/ICO.0b013e31812f6a71","article-title":"Effects of Topical Antiglaucoma Medications on Corneal Epithelium as Evaluated by Gene Expression Patterns","volume":"26","author":"Y. 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Walt","year":"2004","journal-title":"Ocular Surface Disease Index (OSDI) Administration and Scoring Manual"},{"issue":"1","key":"pone.0283597.ref029","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1001\/archophthalmol.2009.356","article-title":"Minimal clinically important difference for the Ocular Surface Disease Index","volume":"128","author":"KL Miller","year":"2010","journal-title":"Arch Ophthalmol"},{"issue":"7","key":"pone.0283597.ref030","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1001\/archopht.119.7.1050","article-title":"Development of the 25-list-item National Eye Institute Visual Function Questionnaire","volume":"119","author":"CM Mangione","year":"2001","journal-title":"Arch Ophthalmol"},{"issue":"10","key":"pone.0283597.ref031","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1001\/jamaophthalmol.2013.4503","article-title":"Development and validation of the Dry Eye-Related Quality-of-Life Score questionnaire","volume":"131","author":"Y Sakane","year":"2013","journal-title":"JAMA Ophthalmol"},{"issue":"1","key":"pone.0283597.ref032","first-page":"1","article-title":"Impact of dry eye syndrome on vision-related quality of life in a non-clinic-based general population","volume":"12","author":"Q Le","year":"2012","journal-title":"BMC Ophthalmol"},{"issue":"1","key":"pone.0283597.ref033","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1186\/s12913-016-1528-x","article-title":"Cost of the medical management and prescription pattern for primary open angle glaucoma (POAG) in Ghana\u2013a retrospective cross-sectional study from three referral facilities","volume":"16","author":"S Ocansey","year":"2016","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"pone.0283597.ref034","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/ICO.0000000000000038","article-title":"A review of quality of life measures in dry eye questionnaires","volume":"33","author":"JRJ Grubbs","year":"2014","journal-title":"Cornea"},{"issue":"3","key":"pone.0283597.ref035","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0002-9394(02)01585-4","article-title":"Progression of visual field loss in untreated glaucoma patients and glaucoma suspects in St. Lucia, West Indies","volume":"134","author":"M Wilson","year":"2002","journal-title":"Am J Ophthalmol"},{"issue":"1","key":"pone.0283597.ref036","first-page":"89","article-title":"Incidence of open-angle glaucoma: the Barbados Eye Studies","volume":"119","author":"M Leske","year":"2001","journal-title":"Arch Ophthalmol"},{"key":"pone.0283597.ref037","volume-title":"Ghana Blindness and Visual Impairment Study 2015","author":"B. 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